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Review
. 2023 Jan 17;24(1):17.
doi: 10.1186/s12931-023-02321-9.

Optimizing molecular testing of lung cancer needle biopsy specimens: potential solutions from an interdisciplinary qualitative study

Florian J Fintelmann  1 , Nikki A Martin  2 , Ismail Tahir  3 , Elissa M Quinn  4 , Timothy C Allen  5 , Lija Joseph  6 , Boris Nikolic  7 , Christopher Lee  8
Affiliations
Review

Optimizing molecular testing of lung cancer needle biopsy specimens: potential solutions from an interdisciplinary qualitative study

Florian J Fintelmann et al. Respir Res. .

Abstract

Background: Molecular testing can detect actionable genomic alterations and tumor cell surface proteins in patients with non-small cell lung cancer (NSCLC). However, utilization remains suboptimal, representing missed treatment opportunities. This study aimed to identify challenges and potential solutions to obtaining percutaneous lung needle biopsy specimens for successful molecular testing in patients with advanced NSCLC.

Methods: This interdisciplinary qualitative study included ten radiologists and four pathologists from academic and community settings across the United States who routinely perform and analyze percutaneous lung needle biopsies. Participants underwent semi-structured one-on-one interviews (Phase 1). Interview questionnaires were constructed based on a literature review of key lines of inquiry and conducted by professional market researchers using the theoretical domains framework. Primary barriers to molecular testing were identified using thematic analysis. Subsequently, multidisciplinary focus groups were convened to identify potential solutions (Phase 2).

Results: Four themes emerged as barriers to molecular testing and were matched to the clinical workflow: (1) biopsy request, (2) biopsy procedure, (3) specimen analysis, and (4) communication. The nineteen potential solutions included adding a "checkbox" to indicate molecular testing in the biopsy request, leveraging pre-procedural imaging to guide biopsies, conserving tissue through appropriate allocation strategies and next generation sequencing panels instead of sequential single-gene assays, instituting reflex-molecular testing upon NSCLC diagnosis, tracking and communicating biopsy outcomes at multidisciplinary tumor boards, and improving integration of radiologists and pathologists into oncology care teams.

Conclusions: Potential solutions exist to increase successful molecular testing of lung needle biopsy specimens in patients with advanced NSCLC.

Keywords: Biomarker testing; Genomic analysis; Lung cancer; Lung needle biopsy; Molecular analysis.

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Conflict of interest statement

Lija Joseph is a consultant for Leica Biosystems. Nikki Martin owns shares in Roche. All other authors declare no relevant conflicts of interest.

Figures

Fig. 1
Fig. 1
Overview of Study Design and Participants Included
Fig. 2
Fig. 2
Geographical overview of participants based on years of experience, type of practice, and speciality
Fig. 3
Fig. 3
Overview of key barriers and potential solutions to obtaining percutaneous lung needle biopsy specimens for successful molecular testing. CT computed tomography, FNA fine needle aspiration, NGS next generation sequencing, NSCLC non-small cell lung cancer, ROSE rapid on-site evaluation
Fig. 4
Fig. 4
Communication feedback loops to optimize molecular testing. ROSE rapid on-site evaluation
See this image and copyright information in PMC

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